Pharmacist, Nurses Team Up to Verify
Hospital Patients’ Medication Lists

Baltimore, MD—Hospital pharmacists teaming up with nurses can help resolve issues around medication lists provided by patients when they arrive and leave hospitals. That not only improves patient safety but also can control costs related to adverse drug events (ADEs) and readmissions.

A Johns Hopkins study of more than 500 patients admitted to and discharged from an urban medical center found the nurse-pharmacist team to be “efficient and cost-effective.” The team was assigned the task of making sure the list of drugs ordered on admission and discharge matched what patients were taking before their hospital stay. The advantage is not only reducing the risk of ADEs but also making sure that chronic diseases remain under control, study authors note.

The problem is a significant one, according to the report in the Journal of Hospital Medicine: More than 40% of the time, unintentional discrepancies were found in the list of drugs patients said they took at home, those they received during the hospital stay, and those that were prescribed on discharge.

Interestingly, the discharge errors were the least common but potentially the most dangerous.

Overall, each additional medication a patient took increased by nearly 9% the odds that there would be a medication discrepancy at some point in the admission-to-discharge process.

“When we give dedicated time for teams of nurses and consulting pharmacists to find and fix discrepancies, patients will be safer and hospitals will be delighted that patients are being readmitted less often in a day and age when readmission is a bad word,” said lead
author Leonard S. Feldman, MD, an assistant professor at the Johns Hopkins University School of Medicine. “It’s just the right thing to do.”

Faced with the confusion of hospital admission, patients struggle to remember everything they take, especially with the burgeoning number of prescriptions to control chronic conditions, Feldman said.

“Many of our patients have limited literacy skills and we expect them to handle three, four or a dozen medications,” he added. “So it’s not hard to imagine that getting accurate medication histories requires some detective work on our part.”

For the study, physicians took a medication history for each of 563 patients, asking them for a home medication list, or HML. In the next part of the study, a nurse interviewed each of those patients and compiled a separate list, checking the electronic medical record or calling the patient’s family, primary care physician, or pharmacist for more information. The patient then was asked to verify the new HML.

When discrepancies were found, a pharmacist was brought in to review them and help the nurses determine what was intended or unintentional—for example, if a physician had purposely changed a prescription upon admission. If the team determined the discrepancy was unintentional, the admitting physician was notified. A similar process occurred at discharge.

Of the 563 hospital patients studied between January 2008 and March 2009, 225 had at least one unintended discrepancy. Unintended discrepancies were more common at admission, but 55% of those rated a 1 on a potential harm scale, meaning they were unlikely to cause injuries or discomfort. At discharge, however, 85% of the unintended discrepancies rated 2 or 3 on the scale, suggesting the potential for moderate to severe harm.

The cost of the reconciliation was about $32 per patient and about $114 to find one discrepancy that could cause harm, according to Feldman. With the cost of each harmful event estimated at about $9,300, preventing just one discrepancy in every 290 patient encounters would offset the expense of the program, according to the study.